Shelf awareness: Experts explain why you should be inspecting your poop

I don't recall exactly when I first discovered the poop shelf. My temporary quarters in the Netherlands are relatively modern, down to the high/low flush option on it toilet, so I didn't catch on right away. But at some point in the journey, I came to realize that elsewhere in the country — as well as parts of Belgium, Germany and Austria —there is a ledge in the back of the bowl. A ledge specifically designed for your business to land before flushing it down. Obviously, I had questions.

"I hate them, they're disgusting, and no one has given me a valid reason why they're good," is how TikToker caseycwolf summed up the situation from Vienna not long ago. But I might never have given much thought for or animosity toward the poop shelf — also known as the inspection shelf — had it not ranked so highly in a recent Reddit thread asking, "Americans, what is something that Europeans have/do that makes no sense to you?" As one European Redditor explained, "It's a diagnostic device. (You can check your product saying goodbye) But I despise it."

Though the poop shelf is less common today, Europeans can definitely still opt for a "flat flush toilet," or vlakspoelcloset, in their own plumbing. "The feces falls onto the flat toilet platform and only ends up in the water when flushing," one German lifestyle brand explains. "This intermediate phase virtually eliminates the risk of splashing," they explain, adding, "Stool samples can be taken more easily here — which is why this model is mainly used in doctors' practices, nursing homes and hospitals."

Perhaps the "platform" serves a primary purpose of avoiding Poseidon's kiss. But the sample taking, or at the very least, inspection aspect of the process has raised some intriguing questions across social media and frankly, my own heart. How much "inspection" is one supposed to be doing in one's average toileting? And what are we supposed to be looking for here, exactly? I just assume I'm dying every time I eat beets and that seems sufficient.

There is a theory that the original poop shelf was to help poopers determine the presence of worms. On one ex-pat's blog about her family's experiences with Germany — and its baffling "lay and display" toilets — a commenter explained that "The shelf toilet was designed at a time (late 1800's and early 1900's) when intestinal worms such as roundworms, tapeworms and especially the highly contagious whip worms, were a common and repeating affliction and so they wanted to be able to inspect the feces for the presence of the vermin so they could take the appropriate vermicide."

The risk persisted well into the 20th century — a 1999 report from the German Federal Institute for Risk Assessment noted an uptick in "mild to fatal zoonosis resulting from a foodborne infection with intestinal round-worms."

But given that trichinosis isn't as pervasive any more — and a rarity in the U.S. — do we still need to be looking behind us before we flush? "You should absolutely be looking at your stool on a regular basis," says Dr. Bryan Curtin, a gastroenterologist at The Institute for Digestive Health and Liver Disease at Mercy Medical Center in Baltimore.

"The number one thing to look for is blood in the stool," he says. "It's not uncommon to have a little bleeding after passing a particularly large or hard stool or see blood on the toilet paper when you wipe, but if the bleeding is painless and especially if it happens on a regular basis this is something that could be a sign of cancer or other significant problem like Crohn's disease. Therefore, you should see your doctor as soon as possible for evaluation." 

It's a crucial habit to get into. When British journalist and podcaster Dame Deborah James was diagnosed with bowel cancer, she made it her mission to destigmatize the disease and raise awareness of its symptoms. In her final message to her fans before she died last year at the age of 40, she urged them once again to "Check your poo – it could just save your life."

But there are other things to be looking — and, I'm sorry, sniffing — for as well when you answer nature's call. "Another sign of illness is if the stool appears pitch black and has an odd smell," Dr. Curtin says. "This is referred to as melena, and generally means that you are bleeding from somewhat in the upper GI tract." (Another advantage of the poop shelf: the pungency factor.)

Curtin also suggests paying attention to any "abrupt change in stool caliber or bowel habit, " including "chronic diarrhea without a known trigger" or "if your stools gradually get much thinner." You should consult your doctor if you have any of these symptoms, as they can also be earning warning signs of cancer.

But it's not just about serious illness — your poop can tell you a lot about your day-to-day health. We spend a lot of time thinking about what we put into our bodies; it's just good sense to pay attention to how it comes out.

Taylor Knese, a family nurse practitioner and owner of Mod Health Co., explains, "I frequently educate my clients on checking their stool after each and every bowel movement. Our stool can tell us so much about the health of our gut!" She explains, "Bowel movements are the body's natural way of eliminating waste and toxins. The color, consistency, frequency and other characteristics can offer valuable insight about your overall health. Hard, cracked, lumpy stool which could indicate dehydration. Unformed, loose or watery stool or undigested food could signal a deeper issue that your body is not properly breaking down and absorbing nutrients from your food. Similarly, clay-colored stool could indicate a lack of bile which our body needs to process food and break down toxins, giving it the characteristic brown color." She suggests, "One useful resource that we use in medicine that can be used at home is the Bristol Stool Chart. You can review the chart to evaluate how your bowels are doing."

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Dr. Supriya Rao, a physician in internal medicine, gastroenterology, obesity medicine, and lifestyle medicine and a managing partner at Gutsy Girl MD, also recommends the Bristol Stool Chart, which as she puts it, "rates your feces." Rao advises, "A 'normal' poop generally resembles sausage links. Your diet can alter this, so pay attention to what you consume and adjust as needed."

You don't need a European style toilet to get in the habit of paying attention to your body's cues, and I remain satisfied with modern toilets and their big, watery, shelf-free bowls. But my exposure to the poop shelf has made me more aware of — and more comfortable with — the life cycle of my own digestion.

Dr. Deepak Vadada, a gastroenterologist with Pinewood Family Care Co. of New York and New Jersey, puts it this way, "Just as we might monitor our skin for changes or keep track of our weight, paying attention to our digestive habits and waste can serve as a proactive approach to health." And Michael Green, an OB/GYN and co-founder at the women's wellness center Winona, says that the experience can even be "educational and empowering." He adds, "While it may not be a pleasant practice, when viewed as for our well-being, checking before you flush can help you better care for your body."